1992, 11-02 Permit App: 92009648 Furnace, Water HeaterMECHANICAL PERMIT AIDPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: R2003 Le voali1
CITY/STATE/ZIP: '-fRourfliqf 9'02 0 PARCEL NUMBER:
OWNER: lP/Cir-d_ 4 bp 7719G.912/-- PHONE NUMBER: 570.2..2- v‘ 9 7
MAILING ADDRESS: "/W/#5E5-3 Cicao03 r peorn -Stearn-I-Lc i -t14 • P5720 ,b
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT <1OOOOO 8Th QMCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUXLET),
BOILER/REFRIG 1-100M BTU
.... .
eolLa.9190k104.014001.44,......
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRI,GAi,0001.1;750M
BOILER/REFRIG +1,750M BTU
HEAT.P.OMP4....AIOQQ,N41.T.)P.Naci..:04ETON .
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT;PQMPA'Alf,700)1/41DITP.N.03.4$4kie.14....-
HEAT PUMP & AIR CONDITIONER 30-50 TONS
l-teATPOMi?....:4•A!0;:p.0)90fr.k0NO.t.2.ttiftoos;:?,;;i:c:t;;!4:i.,
VENTILATING FANS
EVAPORATIVE CdOLEMS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE IIH000
CLOTHES DRYER
RANGE
GAS LOG
MISpELLANEOU(NarcOVEREDfELSEWHERS4.!Si,
UNLISTED GAS APPLIANCE <400,000 BTU
Ut.,.INSTED:GASAFTVANOE:5400,000:BTA./.:i
USED APPLIANCE <400,000 BTU
USED APPLIANCE >4��O�O BTU
AIR HANDLER <10,000 CFM
AIR HANDLER .7.1b;060:bFki:
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
x10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x10.00 =
x10.00 =
x 50.00 =
x10.00 =
x10.00 =
x10.00 =
x10.00 =
x10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675